Prevalence of echocardiographic left atrial enlargement among hypertensive Nigerian subjects

Background: Left atrial enlargement (LAE) predispose to arrhythmias, atrial thrombogenesis and cardioembolic stroke. Whether LAE constitute a major risk among African hypertensive subjects is not well described. This study was aimed to describe the epidemiologic pattern of LAE among hypertensive subjects and determine their correlates. Methods: Clinical and demographic details of 414 hypertensive subjects used were taken. Echocardiography was done. LAE was defined as Left atrial dimension (LAD ) >3.7 cm. Statistical analysis was done using SPSS 17.0. Result: 414 subjects including 258 (62.3%) males were recruited. The mean age was 56.8±16.8 years. LAE was present in 57.73% of hypertensive subjects. Those with LAE were likely to be older (58.23±14.5 vs. 54.8 ±19.7 years, p<0.05), had a higher waist circumference (88.1 ±26.8 ±75.8 ±28.4 cm, p<0.05), left ventricular mass index (79.2 ± 12.4 vs. 48.7 ±15.5g/m2.7 , p<0.05) and a higher frequency of left ventricular hypertrophy (LVH) (65.3% vs. 40.0 %, p<0.05) respectively than those without LAE. LAD was significantly higher among those with LVH than those without LVH (41.4 ±8.4 vs. 35.6 ±5.9 mm respectively, p<0.05). Conclusion: LAE is common among Nigerian hypertensive subjects. Age, waist circumference, left ventricular wall dimension and mass index are the important correlates of LAE in hypertensive Nigerians. Keywords: Left atrial enlargement; hypertension; prevalence; Nigeria

Economic burden and psycho-social implications of Non- Communicable Diseases on adults and their households in South-west Nigeria

Background: Non-communicable diseases (NCDs), are associated with significant economic and psycho-social burden on sufferers. Objective: To compare the economic burden of disease management on adults with NCDs and control subjects in Ogbomoso, Nigeria. Method: A total of 322 participants consisting of 165 adults with at least one of two NCDs - hypertension and diabetes mellitus- and 157 controls (without NCDs) were recruited by stratified random sampling method. The participants were evaluated for the economic burden and psycho-social implications of NCDs on them and on their households. Results: The presence of NCDs was associated with significantly higher psycho-social implication on the subjects including poorer patient-reported personal health assessment, higher frequency of hospital visits and longer average total hours of hospital visits compared to the controls. A significant proportion of subjects with NCDs depended on family supports for their hospital bills (32.7% vs. 7.6%). The total average monthly health expenditure among subjects with NCDs was significantly higher. Catastrophic health expenditure was found in 12.1% of subjects with NCDs who indicated their hospital bills were far higher than their total monthly wages. Conclusion: The management of NCDs is associated with significantly higher psycho-social and economic impact on affected individuals. There is a need for appropriate health insurance scheme and health system financing programs to reduce economic and psycho-social burdens, minimise long-term complications and improve quality of life

Left ventricular hypertrophy, geometric patterns and clinical correlates among treated hypertensive Nigerians

Background: Left ventricular hypertrophy can be due to various reasons including hypertension. It constitutes an increased cardiovascular risk. Various left ventricular geometric patterns occur in hypertension and may affect the cardiovascular risk profile of hypertensive subjects. Methods: One hundred and eighty eight hypertensive subjects were used for this study. Left ventricular hypertrophy was diagnosed by echocardiography. Relative wall thickness was derived by 2 x PWT/LVIDd. Subjects were arbitrarily categorized according to the duration of hypertension. Statistical analysis was done using SPSS 15.0. Results: The mean age of the study population was 55.95±10.71 years. Subjects who had hypertension for >5 years were more likely to be older and had a lower ejection fraction , larger left ventricular diastolic internal dimension than those with duration of hypertensio

Lung functions abnormalities among auto mechanics in Ogbomoso, Nigeria: Clinical correlates and determinants

Background: Auto mechanics are exposed to various organic, inorganic and particulate matters as a result of their occupation. Determining the association between environmental pollutant and risk of lung function abnormalities among auto mechanics is important to prevent long-term morbidity and mortality. Objective: To describe lung function abnormalities and their determinants among auto mechanics in Ogbomoso, Nigeria. Methods: One hundred and three auto mechanics were randomly selected from Ogbomoso, Nigeria. Their clinical and demographic data were obtained using a data form. Spirometry was performed using the CONTEC handheld Spirometer. The personal best values of three measurements FEV1, FVC and PEFR were determined. Lung function abnormalities were described according to standardized criteria. Results: The mean (SD) age of the participants was 38.5 (11.9) years. The mean systolic blood pressure, mean diastolic pressure and mean duration of the job as auto mechanics were 128.7 (17.9) mmHg, 81.2 (11.4) mmHg and 20.2 (12.5) years respectively. Restrictive, obstructive and mixed lung function abnormalities were demonstrated among 53%, 10% and 2% respectively. The mean values of FEV1 and FVC reduced significantly with increasing job duration. Conclusion: Lung function abnormalities occurred frequently among auto mechanics in Ogbomoso, Nigeria. There seemed to be a progressive decline in lung functions with age and duration of exposure to organic and inorganic pollutants by auto mechanics. Strict environmental and occupational safety measures may limit the hazards associated with poor air quality and other chemical/physical hazards among auto mechanics in Nigeria

Gestational headaches: characteristics and influencing factors in South-Western Nigeria

Background: Headache is one of the common neurological diseases in pregnancy but its pattern and influencing factors are yet to be determined in our environment in Nigeria. The aim of this study was to determine the prevalence and characteristics, as well as the modifying factors for gestational headaches in Ogbomoşo, Nigeria.Methods: This study was a bi-institutional cross-sectional descriptive study. Three hundred and eight (308) eligible pregnant women attending the ante-natal care of the Ladoke Akintola University of Technology and Ogbomoso South local government hospitals in Ogbomoso were recruited consecutively, between November10, 2012 and February 28, 2013. Using an interviewer administered questionnaire, socio-demographic, obstetrics and headache related variables were obtained from eligible pregnant women. Gestational headaches were characterized using the international classification of headache disorders II (ICHD-II). The prevalence of migraine and tension type headache were determined before and during pregnancy. Improvement rates (defined by reduced headache frequency and severity) were determined.Results: The prevalence of Headaches before and during pregnancy was 25% and 23.3% respectively (P = 0.661).Migraine prevalence was 8.4% and 5.5% before and during pregnancy respectively (P = 0.34); while the prevalence of Tension-Type Headaches (TTH) was 16.5% and 17.9% before and during pregnancy (P = 0.63). Improvement rate was 100% for migraine and 85.5% for TTH. Multiple logistic regressions revealed that poor personal income, unemployment and multi-parity were predictive factors for headaches in pregnancy.  Conclusions: Migraine and Tension type headaches were prevalent in this population and they are worsened by poor personal income, unemployment and multi-parity. Interventions and programs to subsidize antenatal care may prevent gestational headaches in this population.

Snoring and obstructive sleep apnoea syndrome among hypertensive Nigerians: Prevalence and clinical correlates

Background: Obstructive sleep apnoea (OSA) syndrome is a common disorder in the community. Association between hypertension and sleep apnoea and /or snoring has been described. The Berlin questionnaire is a validated instrument that is used to identify individuals who are at risk for OSA. The study aim to describe the prevalence of snoring and OSA among hypertensive subjects in South Western, Nigeria. Methods: This was a descriptive study conducted at the Cardiology clinic of Ladoke Akintola University of Technology LAUTECH Teaching Hospital, Osogbo, South West Nigeria. One hundred consecutive hypertensive patients were recruited from the clinic. The Berlin questionnaire and the Epworth sleepiness scale (ESS) were used to determine excessive daytime sleepiness and the risk of having OSA. Statistical analysis was done using SPSS 16.0. Data were summarized as means ± S.D and percentages. Results: The study participants consisted of 40 males (40.0%). The demographic data were similar between both genders except that females had higher mean body mass index than males. The prevalence of snoring was 50.0%. 52% were categorized as being at high risk of having OSA. Snorers were more likely to be older, males and to have a higher fasting blood sugar than non-snorers.96% of snorers reported excessive daytime somnolence as predicted by the ESS score compared to 4% of non snorers. Prevalence of snoring was also higher among overweight and obese hypertensive subjects than normal body mass index hypertensive subjects. Conclusion: Snoring is common among hypertensive subjects in South Western Nigeria. Clinically suspected OSA was similarly high in prevalence among them. Early identification and management may reduce the cardiovascular risk of hypertensive subjects

Physiological Phenotyping for Personalized Therapy of Uncontrolled Hypertension in Africa

OBJECTIVES African and African American hypertensives tend to retain salt and water, with lower levels of plasma renin and more resistant hypertension. We tested the hypothesis that physiological phenotyping with plasma renin and aldosterone would improve blood pressure control in uncontrolled hypertensives in Africa. METHODS Patients at hypertension clinics in Nigeria, Kenya, and South Africa with a systolic blood pressure \u3e140 mm Hg or diastolic pressure \u3e 90 mm Hg despite treatment were allocated to usual care (UC) vs. physiologically individualized care (PhysRx). Plasma renin activity and aldosterone were measured using ELISA kits. Patients were followed for 1 year; the primary outcome was the percentage of patients achieving blood pressure \u3c140 mm Hg and diastolic \u3c90 mm Hg. RESULTS Results are presented for the 94/105 participants who completed the study (42 UC, 52 PhysRx). Control of both systolic and diastolic pressures was obtained in 11.1% of UC vs. 50.0% of PhysRx (P = 0.0001). Systolic control was achieved in 13.9% of UC vs. 60.3% of PhysRx (P = 0.0001); diastolic control in 36.1% of UC vs. 67.2% of PhysRx, vs. (P = 0.003). Number of visits and total number of medications were not significantly different between treatment groups, but there were differences across the sites. There were important differences in prescription of amiloride as specified in the PhysRx algorithm. CONCLUSIONS Physiologically individualized therapy based on renin/aldosterone phenotyping significantly improved blood pressure control in a sample of African patients with uncontrolled hypertension. This approach should be tested in African American and other patients with resistant hypertension. Registered as ISRCTN6944003

High frequency of variants of candidate genes in black Africans with low renin-resistant hypertension

OBJECTIVES Black subjects tend to retain salt and water, be more sensitive to aldosterone, and have suppression of plasma renin activity. Variants of the renal sodium channel (ENaC, SCNN1B) account for approximately 6% of resistant hypertension (RHT) in Blacks; other candidate genes may be important. METHODS Six candidate genes associated with low renin-resistant hypertension were sequenced in Black Africans from clinics in Kenya and South Africa. CYP11B2 was sequenced if the aldosterone level was high (primary aldosteronism phenotype); SCNN1B, NEDD4L, GRK4, UMOD, and NPPA genes were sequenced if the aldosterone level was low (Liddle phenotype). RESULTS There were 14 nonsynonymous variants (NSVs) of CYP11B2: 3 previously described and associated with alterations in aldosterone synthase production (R87G, V386A, and G435S). Out of 14, 9 variants were found in all 9 patients sequenced. There were 4 NSV of GRK4 (R65L, A116T, A142V, V486A): At least one was found in all 9 patients; 3 were previously described and associated with hypertension. There were 3 NSV of SCNN1B (R206Q, G442V, and R563Q); 2 previously described and 1 associated with hypertension. NPPA was found to have 1 NSV (V32M), not previously described and NEDD4L did not have any variants. UMOD had 3 NSV: D25G, L180V, and T585I. CONCLUSIONS A phenotypic approach to investigating the genetic architecture of RHT uncovered a surprisingly high yield of variants in candidate genes. These preliminary findings suggest that this novel approach may assist in understanding the genetic architecture of RHT in Blacks and explain their two fold risk of stroke

The impact of systemic hypertension on outcomes in hospitalized COVID-19 patients – a systematic review

Background: Several observational reports from different parts of the world have shown that systemic hypertension (hypertension) was the single commonest comorbid condition in hospitalized COVID-19 patients. Hypertension is also the most prevalent comorbidity reported among patients who developed severe disease, were admitted to Intensive Care Unit, needed mechanical ventilatory support, or who died on admission. The objective of this systematic review is to study the association between hypertension and specific clinical outcomes of COVID-19 disease which are- development of severe COVID-19 disease, need foradmission in the intensive care unit (ICU) or critical care unit (CCU), need for mechanical ventilation or death Methods: We searched the PubMed, SCOPUS, and Google Scholar databases up till June 28, 2020 for original research articles that documented the risk factors of mortality in patients with COVID-19 using the PRISMA guideline. Results: One hundred and eighty-two articles were identified using pre-specified search criteria, of which 33 met the study inclusion criteria. Only three were prospective studies. Most studies documented hypertension as the most prevalent comorbidity. The association of hypertension with development of severe COVID-19 disease was not conclusive, majority of studies however found an associated with mortality. Conclusion: Hypertension affects the clinical course and outcome of COVID-19 disease in many cohorts. Prospective studies are needed to further understand this relationship. Keywords: Hypertension and COVID-19; SARS –Cov-2; severity; mortality; ICU care; mechanical ventilation